Qualitative Research Critique and Ethical Considerations
Falls are a common occurrence for people with dementia living in nursing homes, especially when they try to stand. Numerous articles have been dedicated to discussing these falls with regard to their causes and effects as well as the interventions that medical practitioners can incorporate to prevent these falls. This paper will review two of those scholarly articles and use their findings to describe interventions that can be incorporated in nursing practice to prevent these falls.
The first qualitative research article discusses strategies for preventing falls in older people in assisted living facilities and hospitals, intending to find out the degree of their effectiveness. The study begins with a background explaining the prevalence of falls in care facilities among older people. According to Cameron, et al. (2018), these falls can result in injuries, loss of independence, and even death. Therefore, it is important to develop strategies that can effectively prevent these falls together with the effects they cause. Some of the strategies that have already been set in motion for older adults to engage in include regular exercise, vitamin D supplementation, and regular drug reviews. Also, investing in versatile technologies such as special beds and chairs, and social campaigns for families and organizations to equip them with knowledge and skills on how they can assist are effective measures (Cameron, et al., 2018). However, the authors emphasized the need for adopting a multifactorial approach of intervention to increase the effectiveness of the prescribed interventions. The article reviews the degree of effectiveness with relevance to the risk of falling and the rate of falls.
The research incorporated 95 RCTs (randomized control trials) with a total of 138, 164 participants. The RCTs were divided between hospitals and care facilities where the research was to take place. Twenty-four trials incorporated 97,970 participants in hospitals while the remaining seventy-one trials involved 40,374 participants in care facilities. the participants in hospitals were on average 78 years old while those in care facilities had an average of 84 years old. The percentage of female participants in hospitals and care facilities was 52% and 75% respectively.
The study found that 75% of falls among older adults occurred when in their rooms or the bathroom. More so, falls occurred either when they were walking (41%) or during transfers (36%). The study further discovered that the rates of falling among men (2.8 falls per person every year) was higher than in women (1.5 falls per person every year). Further, older adults requiring the most and least care were less likely to fall. Those in need of most care always had someone looking out for them hence the low risk and rate of falling. Similarly, those in need of less care were in better shape healthwise and could thus maintain their balance, hence the few to no falls. According to Cameron, et al. (2018), factors such as male gender, psychoactive prescriptions, advanced age, slow reaction periods, and previous falls indicated increased risk and rate of falling. The factors specific to dementia fall as discussed by the authors include advanced age, poor health, treatment with psychotropic prescription, impaired gait, and trunk restraint therapy. All factors considered, the study found that a multidimensional approach – where multiple interventions are involved – is more effective than a single-handed approach. These findings can be used in nursing practice to improve the effectiveness of interventions and subsequently prevent falls in patients with dementia. An example can be using the information about the high risk posed to individuals that have fallen previously or those whose age has advanced and need more assistance than others to incorporate measures that specifically prevent them from falling. Ethical considerations associated with this study relevant to the study group involved seeking consent from the participants, their families of their caretakers, and doing the best to safeguard their wellbeing.
The second qualitative research article discusses falls, physical restraints, and wandering among people with dementia living assisted care facilities and nursing homes. Tilly & Reed (2006) state that falls and wandering as the major consequences of dementia. The commonly used intervention to prevent both falling and unsafe wandering has been physical restraint, which albeit effective, is termed by the authors as a “misguided” effort towards keeping dementia patients safe from harm. The authors proceed to suggest that nursing practice involving dementia patients in nursing homes should be guided by a detailed understanding of the condition together with potential effective measures to prevent falls and wandering.
The authors majorly used secondary sources for the research, including 109 published articles from 1994 to 2006. These articles provided the authors with enough material for their literature review and a myriad of interventions that could be used to prevent the unsafe wandering and falls among residents of nursing homes diagnosed with dementia. The research articles used the experimental research design, specifically the quasi-experimental approach, allowing for the manipulation of the independent variable. On reviewing the articles, the authors found out that the most prevalent issue affecting residents with dementia was falls – there was little information about unsafe wandering. A majority of the articles used the quasi-experimental design approach to uncover useful interventions aimed at reducing and preventing falls. Some of the common strategies that were highlighted in several of the articles include the development of a regular exercise routine specific to the patients’ needs, review of drugs commonly prescribed to the residents, adjustments in the environment to suit the resident’s needs. The study concluded that while the use of physical restraint may prevent falls, it is not an effective measure as it may end up harming them in other ways. The demerits of imposing physical restraints upon people with dementia override the benefits (Tilly & Reed, 2006). The study also emphasized the need to safeguard the dignity of nursing home residents by developing tailored measures to prevent them from falling.
The findings for this article may be used in nursing practice to assist care providers in developing more effective and reasonable strategies for preventing falls among people with dementia. The article summarizes the interventions found in the reviewed articles and this can give care providers insight on the multiple approaches to adopt when dealing with residents with dementia. Further, these findings can help nursing practitioners working in nursing homes to improve patient outcomes by preventing falls over a long period (Tilly & Reed, 2006). The researchers of this article incorporate ethical considerations by working towards improving the care given to nursing home residents with dementia – saving them from harm instead of subjecting them to it. For instance, invalidating the practice of physical restraint – which can be harmful to people with dementia – addresses ethical considerations. Similarly, the review of effective intervention methods gives care providers insight on how to protect their patients from falling, further exemplifying ethical considerations.
References
Cameron, I. D., Dyer, S. M., Panagoda, C. E., Murray, G. R., Hill, K. D., Cumming, R. G., & Kerse, N. (2018). Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Library. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6148705/
Tilly, J., & Reed, P. (2006). Falls, Wandering, and Physical Restraints: Interventions for Residents with Dementia in Assisted Living and Nursing Homes. Alzheimer’s Association. Retrieved from https://www.alz.org/national/documents/fallsrestraints_litereview_ii.pdf